Well, here is my 2 cents worth of input:

PSA/uPSA testing remains confusing to me in a couple of ways.

What I have seen in various sources:

After RP, undetectable has been identified as < .1

After radiation as primary tx, < .2 as a "goal". However PSA reading should go down over time until each man reaches a nadir, and then follow from there.

Focusing on RP only at 72 w/ G 9 and EPE; my initial PSA postop was .19 (confirmed. 18), resulting in immediate referral to Rad Onc.

Salvage radiation plus 4 mos short term ADT.

Blessedly 1st post salvage tx uPSA < .02 undetectable at Quest Labs, the lower limit of its testing accuracy.

Note: Johns Hopkins uPSA testing floor < .03

The difference, as well as lower testing floors, are a mystery to me.

And, a rad tx friend with a different Rad Onc was tested post salvage tx at JH using the std PSA and was reported as < .1 undetectable. Do not know why the different test used.

Generally: Salvage radiation tx post RP initiated at .2 - .4/.5 is the "sweet spot"

See SPPORT trial and PCI video on rising PSA following tx Jan 2023.

However some Rad Oncs initiate tx earlier.

Comment: salvage radiation tx w/ or w/o ADT should be covered by insurance under any scenario when Dr deems it medically necessary.

"Step therapy", such as a bone scan before a PSMA PET scan or denial of treatments still deemed "experimental " are insurance company issues/requirements.

While I am ruminating, Orgovyx is a prescription drug (my Part D Medicare drug plan covered it at a 25% coinsurance; reached catastrophic coverage stage after 4 scrips; the math eluded me).

Eligard/Lupron should be covered more comprehensively under Medicare Part B as injectable.

After 4 mos of Orgovyx, my side effects 95% gone; Testosterone at 1st post tx testing (about 5 mos after completion) had recovered to 274 (439 prior to tx).

And we are informed that PSMA PET Scan only 20 - 30 % reliable at PSA less than .2

I had PSMA PET Scan after RP and prior to Salvage tx which did not identify PCa, and in that situation, the belief is that cancer cells remain in the prostate bed and possibly the prostate lymph nodes (plns).

So radiation to the whole pelvic floor (WPRT) as well as plns prescribed and performed together w/ short course ADT.

So following initial tx decision between RP or Radiation, it appears that the next steps are more varied and Dr dependent.

All somewhat disconcerting.

End where I began: I do not understand the why's and wherefores of the different PSA tests and testing limitations.

May the New Year bring better health and happiness to all. And God bless us, everyone.